IVF or IUI? Should you do IUI or go straight to IVF? What are the advantages of IVF and IUI? Get all your questions answered by Dr Natasha Ain in this interview.
GetDoc: How do you know if a patient is a good candidate for IVF?
Dr Natasha: If you have issues in conceiving, and after trying for one year, you may consult a fertility specialist. A good candidate is one who is in overall good health. Beyond that basic requirement, some other criteria we can look at include:
- Age – If the woman is 35 and above, and she’s been trying for more than 5 years, but unable to conceive yet.
- Endometriosis – IVF can offer a way forward for patients who have Endometriosis. Endometriosis can affect the quality of the egg, and the number of eggs, and also the tubes. So pregnancy rate is much better with the IVF compared to other fertility treatments.
- If you have scarred, blocked, damaged or missing Fallopian tubes, IVF is an excellent option, as the IVF process bypasses the Fallopian tubes entirely. It’s often a more effective (and less invasive) alternative to surgical options that unblocks the damage tubes.
- Women who have been unsuccessful with other fertility treatments, including fertility medications and IUI (intrauterine insemination). IVF often offers hope where other methods have failed.
- Failed IUI several times.
GetDoc: Why will a patient choose IVF over IUI?
Dr Natasha: It depends on the patient’s preferences. Some patients do understand they have a problem but it is not as big, and they do not want to go through multiple IUI sessions. So for them we start from IVF.
Some patients prefer to try several times of IUI before moving on to IVF. So there are no rules, but those are the common reasons a patient might go for IVF.
GetDoc: Have you seen patients that you know do not fit into the criteria for IVF, but they still want to do it?
Dr Natasha: There are a minority of patients who have problems with sexual intercourse due to vaginismus and are perhaps of older age. Sometimes they would opt straight to IVF to have a better success rate.
GetDoc: How about patients who prefer other methods such as IUI, but they are actually good candidates for IVF?
Dr Natasha: There are usually a few reasons why suitable patients for IVF defer their treatment and opt for IUI. Most common reason is due to financial constraint. Hence, I will try to find out more information about the patient’s background such as age, problems faced, how long they have been married, what their budget is, state of the Fallopian tubes, what treatments they have tried, what they haven’t tried. With this information, I will recounsel the patient and let them decide what they would like to do.
I do have a quiz published online for those couples who want to know if they are good candidates for IVF.
In addition, if budget constraint is withholding the patient form IVF, I may offer a low intervention IVFku program available in KL Fertility Centre called IVFku.
GetDoc: Who are the patients that may not benefit from IVF?
Dr Natasha: Patients with no eggs no sperm.
GetDoc: Can they use donor’s egg?
Dr Natasha: Malay and Muslim couples cannot use donor’s egg. Non-Muslims couples can explore this option.
GetDoc: Does KL Fertility Centre accept any couple who wants to go through IVF treatment?
Dr Natasha: There are some couples who have had, say, 4 boys, and would like a girl for their next one. They will come in and hope IVF can give them a baby girl. That is common. However, we do not do social gender selection here.
Patients are free to do IVF because of other reasons such as tight Fallopian tubes. However, we are quite strict in terms of gender selection because we feel that it is not an ethical thing to do. Furthermore this is actually prohibited under the Ministry of Health’s Guidelines.
GetDoc: How many times does a patient need to try IVF before it works?
Dr Natasha: I would say at least a good 2 to 3 cycles. Patients may undergo several cycles before pregnancy occurs. Although some people do experience pregnancy after the first in IVF cycle, the fact is that majority go through several cycles before being successful. Because of this, it is best to go through IVF when you are prepared financially and emotionally for that possibility.
Major factor of a successful IVF is age, that’s why we encourage patients to start early and not give up should they face any challenges. During IVF cycle, when we doctors extract the eggs, there will be extra embryo surplus for future use, as we understand that patients don’t like daily injections, and the scanning. So when the IVF fails, we can make use of the embryo surplus. This means that the process of maturing and collecting eggs will not be necessary. Embryo freezing costs about much less than a full IVF cycle, which means that it can help minimize costs and stress.
GetDoc: Will several IVF cycles improve the success rate?
Dr Natasha: Statistics show that the success rate jumps to 60 to 70% as you undergo 2 to 3 cycles of IVF, which is good. So, three-quarters of patients will eventually have their baby.
For second or third round, we do have some advantages in term of finding out whether the dose is sufficient, how many eggs were collected, what were the results, whether there is an implantation issue, egg or sperm issue. From there, we can start adjusting and implement strategies to improve the pregnancy rate.
In addition, we do accept complimentary treatments like Traditional Chinese Medicine, which could help improving sperm and egg quality.
National Institute for Health and Care Excellence (NICE) from UK actually recommended 3 full cycles of IVF, citing that the cumulative effect of three full cycles of IVF increases the chances of a successful pregnancy to 45-53%.
GetDoc: Why do the chances increase after few attempts?
Dr Natasha: Probably because a few reasons – maybe you have adjusted your body condition, another reason could be that the embryos that are left being selected, or it could be just a matter of chance.
After choosing better quality embryo, we can do a blastocyst transfer, then that probably would improve the pregnancy rate.
GetDoc: How about having miscarriage during IVF?
Dr Natasha: It’s common to have pregnancy loss, but obviously it’s devastating for the couple and us here.
We will do a blood test which tells us a little bit about the prognosis. 15% of the couples will have a miscarriage because it’s not a healthy baby. What we do is sometimes we have an extra test for those with recurring miscarriage problem, most likely it is because baby is not normal. We will biopsy the embryo via a technique known as PGS, so it reduces the risk of miscarriages for older women.
GetDoc: What is the next step if the patient knows that she is a good candidate for IVF?
Dr Natasha: To come to this stage, I usually would have already assessed them. So the next step is we usually see them at least for 1 cycle, to see how their body works naturally. We see them on the first, 2nd day, 3rd day of their period, do blood test screening, to prepare and also for infection screening.
Patient will then come back again on day 12-13 of their menses to check their lining, to see whether there are any other issues that are going to impede the implantation.
In addition, we also assess the partner’s sperm. To optimize the outcome of IVF, the patient’s overall health must be improved. Loosing that excess weight, have a healthy balanced diet and regular exercise could do a lot to improve the quality of egg and sperm. I would suggest doing this at least 1 to 2 months before starting your IVF, especially if you had a previous IVF failure, consult with your doctor. This is because we as fertility doctors would like you to have a successful treatment and aim to optimize this as much as possible.
This article was first published here.